MEDICINE

Human Systems in Health and Disease BMS 6047

Musculoskeletal and Integumentary Systems

Florida State University

College of Medicine

Foundations of Medicine 

Human Systems in Health and Disease 

Preparation for  

 

Core Clerkships 

and Electives 

Advanced Clerkships 

and Electives 

Preparation for Residency 

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Table of Contents

Table of Contents ........................................................................................................................................................................................................... 2 Faculty and Staff ............................................................................................................................................................................................................. 3

Course directors......................................................................................................................................................................................................... 3 Clinical Skills Director ................................................................................................................................................................................................ 3 Preceptorship Director ............................................................................................................................................................................................... 3 Faculty ....................................................................................................................................................................................................................... 3 Course Support .......................................................................................................................................................................................................... 3 Preceptorship Support .................................................................................................................................................................................................

Table of Contents ................................................................................................................................................................................................................ 2 Faculty and Staff .................................................................................................................................................................................................................. 3

Course directors.............................................................................................................................................................................................................. 3 Faculty ............................................................................................................................................................................................................................ 3 Course Support ............................................................................................................................................................................................................... 3

Overview .............................................................................................................................................................................................................................. 4 Course Goals .................................................................................................................................................................................................................. 4

Course Objectives mapped to Education Program Objectives (EPO) ................................................................................................................................. 4 Course Format ................................................................................................................................................................................................................ 6 Preceptorship (attendance required) .............................................................................................................................................................................. 6 PICO Assignment ........................................................................................................................................................................................................... 6 Critical Reading/Critical Analysis of Literature Assignment (aka Journal Club) .............................................................................................................. 7 Interprofessional Collaborative Skills (ICS) ..................................................................................................................................................................... 7 Professionalism............................................................................................................................................................................................................... 7

Content ................................................................................................................................................................................................................................ 8 Grading System ................................................................................................................................................................................................................... 9

Description of Student Assessment Methods and Grading ............................................................................................................................................ 9 Grading ........................................................................................................................................................................................................................... 9 Preclerkship course grading policy – Year 2 ................................................................................................................................................................. 11 Pre-clerkship course remediation policy – Year 2: ........................................................................................................................................................ 11 Course Evaluation......................................................................................................................................................................................................... 12

Policies .............................................................................................................................................................................................................................. 13 Americans with Disabilities Act ..................................................................................................................................................................................... 13 Academic Honor Code .................................................................................................................................................................................................. 13 Attendance Policy ......................................................................................................................................................................................................... 13

Clinical Learning Center (CLC) Specific Absence Policy ................................................................................................................................................... 14 CLC scheduled activities ............................................................................................................................................................................................... 14 Objective Structured Clinical Examination (OSCE) ...................................................................................................................................................... 14

Professional Attire .............................................................................................................................................................................................................. 14 FSU COM Education Program Objectives ......................................................................................................................................................................... 16

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Faculty and Staff

Course Directors Eric Laywell, PhD Alice Pomidor, MD Professor, Biomedical Sciences Professor, Geriatrics Office: 2350-F Office: 4310 Phone: 645-9817 Phone: 645-8441 Email: eric.laywell@med.fsu.edu Email: alice.pomidor@med.fsu.edu

Clinical Skills Directors

Mary Norton, MD Ramiz Kseri, MD Assistant Professor, Clinical Sciences Assistant Professor, Clinical Sciences Office: 3140-A Office: 3140-H Phone: 645-9380 Phone: 645-2183 Email: mary.norton@med.fsu.edu Email: ramiz.kseri@med.fsu.edu

Director, Clinical Learning Center and Preceptorship Director, Interprofessional Education

Debra Danforth, DNP, APRN Niharika Suchak, MD Associate Professor, Clinical Sciences Associate Professor,Geriatrics Office: G129-M Office:4311 Phone: 645-7123 Phone: 644-2372 Email: debra.danforth@med.fsu.edu Email: niharika.suchak@med.fsu.edu

Faculty

Course Support

curriculum.support@med.fsu.edu CLC@med.fsu.edu Curriculum Coordinators: CLC Program Coordinator Cesar Arango Sharika Brown Steve Walden Office: Suite 2200-N Office: Suite 2200-P Office: Suite 2200-R Office: G129-N Phone: 645-2905 Phone: 645-4645 Phone: 644-2907 Phone: 645-9236

John Agens, MD M. Bryant Howren, PhD Steve Quintero, MD Jon Appelbaum, MD Jerome Irianto, PhD Raed Rizkallah, PhD David Bellamy, MD Paul Katz, MD George Rust, MD/MPH Joedrecka Brown-Speights, MD Ramiz Kseri, MD Stephen Sandroni, MD Rob Campbell, MD Eric Laywell, PhD Benjamin Smith, MPAS, PAC Erin Carlquist, MD Cathy Levenson, PhD David Stewart, MD Kerwyn Flowers, DO Ron Mageau, MD Mike Sweeney, MD Joe Gabriel, PhD David Meckes, PhD Greg Todd, MD/JD Lisa Granville, MD Michael Nair-Collins, PhD Dan Van Durme, MD Suzanne Harrison, MD Mary Norton, MD Yanchang Wang, PhD Mel Hartsfield, MD Mike Overton, PhD Andrew Wong, MD Shermeeka Hogans-Mathews, MD Alice Pomidor, MD

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Overview

Course Goals

In the Musculoskeletal and Integumentary Systems block, students acquire a fundamental knowledge of the structures and functions of these systems in the context of caring for patients. Students learn principles of recognition and management of musculoskeletal and integumentary disorders, including autoimmune and rheumatologic diseases, and knowledge of the medications used in their treatment. Through active exploration of case-driven problems, students discover how basic science and clinical medicine explain the signs and symptoms of musculoskeletal and integumentary disorders that are likely to be seen by the primary care physician. They learn how to evaluate clinical history, physical examination, and laboratory data related to musculoskeletal, integumentary and rheumatologic disorders using an “evidence-based” approach. COM mission-based domains are underscored in specific objectives that address important issues in geriatric, rural and other underserved populations, such as age-related changes in skin that predispose elderly patients to injury. Curricular themes such as cultural issues, ethics, and public health are developed as essential components in clinical encounters with standardized patients and in case studies, for example, the impact on skin care of cultural attitudes about beauty, and the disparities in vulnerability to arthritis and joint degeneration associated with employment and socioeconomic status. Our goal is to help our learners acquire a mastery of concepts that will allow them to perform as exemplary clinicians in any area of practice, long after the course has been completed.

Course Objectives mapped to Education Program Objectives (EPO)

Course Objectives EPOs Means of Assessment

1 

Demonstrate effective communication with patients and their families from diverse backgrounds, including culturally and linguistically appropriate interviewing skills, appropriate use of an interpreter, and culturally appropriate verbal and non‐verbal behaviors that promote building rapport and trust, and accurate and appropriate vocabulary and concepts about musculoskeletal disorders and diseases of the skin. 

2.2, 2.3, 4.1, 5.5 

Observation by faculty, staff and Standardized Patients 

2 

Demonstrate the ability to perform, interpret and report the results of pertinent patient‐centered history, physical examination and diagnostic testing regarding the musculoskeletal and integumentary systems across the lifespan. 

1.2, 1.3, 5.1, 5.5 

Observation by faculty and staff 

3 

Demonstrate clinical skills and clinical reasoning necessary for diagnosis, evaluation, and management of musculoskeletal, rheumatological, and dermatological disorders and diseases, including selection and interpretation of appropriate diagnostic imaging and testing and development of a management plan. 

1.2, 1.4, 1.6, 2.3 

Observation by faculty in CLC and small groups 

4 

Describe the basic physical properties and imaging characteristics of ultrasound, and identify opportunities, advantages, and limitations for its point‐of‐care use related to the musculoskeletal and integumentary systems. 

1.1, 1.2, 1.4, 2.3 

Observation by faculty in CLC and small groups, SonoSim modules

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Compare and contrast the normal and abnormal structures (including microscopic anatomy) and functions of the musculoskeletal and integumentary systems, including: genetic and environmental factors, host‐defense functions of the integumentary system, and significance of cutaneous microbiological flora in relationship to disease, and anticipate the clinical effects expected to result from injury, disease and environmental factors impacting the musculoskeletal and integumentary systems, including the rheumatologic disorders 

2.2, 2.3, 2.4 

Observation by faculty in small groups; Quizzes and exam 

6 Identify, describe and distinguish tissue and cell types using photomicrographs and by virtual microscopy 

2.2  Quizzes and exam

5

 

Anticipate the psychosocial effects expected to result from injury, disease and environmental factors impacting the musculoskeletal and integumentary systems, including the rheumatologic disorders, and describe their appropriate identification, prevention and management, including pharmacologic and non‐pharmacologic approaches, using principles of high value care 

2.2, 2.3, 2.4, 2.5 

Observation by faculty in small groups; Quizzes and Exam

 

Describe principles of pharmacologic and non‐pharmacologic treatment and strategies for the prevention and management of musculoskeletal and integumentary disorders including autoimmune and rheumatologic diseases, and demonstrate knowledge of the medications used in their treatment including mechanism of action, kinetics, major adverse effects and drug interactions 

2.2, 2.3, 2.4, 2.5 

Observation by faculty in small groups; Quizzes and Exam

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Interpret clinical presentations, including symptoms, signs, and/or laboratory findings based on an understanding of the structure and function of the musculoskeletal and integumentary systems, and communicate diagnostic information and reasoning, intervention options, and a suggested plan of care with truthfulness, sensitivity and empathy. 

2.2, 2.3, 2.4, 4.6 

Exam; Observation by faculty in small groups

8 Describe the features, strengths, and weaknesses of health care systems and their impact on patient participation and outcomes 

6.4  Observation by faculty in small groups; Exam

9 Demonstrate the ability to recognize when one has reached the limits of their knowledge when applying it to understanding clinical problems. 

3.1  Observation by faculty; Self-assessment

10 Demonstrate the habits of life‐long learning – the identification of personal knowledge gaps and application of strategies to find and interpret information to address those gaps 

3.1, 3.2, 3.3, 3.6 

Observation by faculty; participation in case-based learning activities; PICO assignment

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Demonstrate an understanding of biostatistics and epidemiology concepts and their application in health care, the ability to interpret and appraise the validity of study design and results in the medical literature, and the ability to apply these skills in a systematic approach to clinical problem solving. 

2.4, 3.6, 3.7, 3.8 

Quizzes and exams; Biostatistics problem set; Critical analysis of literature assignment; PICO assignment

12 Apply the principles and methods of Evidence‐Based Medicine to acquire, appraise, and assimilate new clinical information to improve patient care 

3.6, 3.7, 3.8  PICO assignment

13 Demonstrate effective communication with colleagues and other health professionals, and the ability to clearly and accurately summarize patient findings in verbal presentations and common written formats. 

4.2, 4.5, 7.3, 7.4 

Observation by faculty; SOAP note; Interprofessional Collaborative Skills reflection

14 Identify social determinants of health and discuss their relationship to health and wellness, including for underserved populations 

2.4, 2.5, 9.1, 9.2 

Exam; participation in small group discussions

15 

Engage in self‐evaluation and reflection, including related to cultural, moral and ethical issues encountered in the care of patients, to identify biases, to develop self‐awareness of knowledge, skill and emotional limitations, to set learning and improvement goals, and to engage in appropriate help‐seeking behaviors 

3.1, 3.2, 4.7, 5.5, 8.1 

Observation by faculty, staff and advisors; participation in small group discussion and case-based learning activities

16 

Demonstrate professional attitudes and behavior in all interactions with faculty, staff, peers, and patients, and in all activities, including: maintaining confidentiality for patients who participate in the course; demonstration of respect, empathy, compassion, responsiveness and concern regardless of the patent's problems or personal characteristics; integrity and adherence to ethical standards including informed consent; and completion of all required activities in a timely fashion 

1.7, 5.1, 5.3, 5.4, 5.5, 5.6 

Observation by faculty, staff and peers; Interprofessional Collaborative Skills reflection; tracking of required activities

 

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Detailed learning objectives are provided for each session in the course.

Course Format

The course emphasizes engaged and active learning through a variety of individual, interactive large group, and case-based small group learning activities as well as encounters in the Clinical Learning Center. Formative on-line assessment materials emphasize the development of thinking skills through analysis of data and cases, including biostatistics and epidemiology and NBME/USMLE-type questions. Students are expected to self-assess their learning needs and set goals to address them with the aid of faculty and their learning groups.

Large Group Sessions

Formal lectures are limited in favor of interactive large group sessions. This learner-centered model uses the principles of active learning, where students consolidate their understanding and identify gaps in understanding as a session evolves, by answering questions and solving problems individually and through peer discussion, with immediate input of faculty expertise. Pre-class preparation recommendations prime students for learning with basic didactic material presented through OnlineMedEd, including assigned videos with companion notes, formative questions and challenge questions, as well as a variety of additional materials, including interactive modules, self-assessment exercises, video and PowerPoint presentations, textbook and journal readings, and structured vertical reading exercises. Advanced preparation and trust in the safe environment we maintain to encourage students to be curious and even to take intellectual risks allows students to be active participants in large group sessions. Clinical Skills activities each week include a 50 minute lecture or large group session before the Clinical Reasoning small group session. The emphasis is on developing integrated basic and behavioral science concepts in a clinical context. Whenever possible, real patients will be present to share their stories and demonstrate signs of their disease. Whenever patients are present, we ask that students wear their white coats and close their mobile devices as demonstration of respect for these wonderful patients who are willing to help us learn. . Small Group Sessions (attendance required)

Small group exercises are case- and/or problem-oriented. Some sessions pattern thinking through progressive disclosure, others focus on concept development through guided engagement with data, while others employ the Jigsaw paradigm to focus on discovering similarities and differences of presentations or aspects of disease – the basis of differential diagnosis. Small group exercises are designed for engaged and active learning and emphasize reasoning, hypothesis formation, and hypothesis testing. The groups evaluate cases in terms of stated objectives and define additional learning objectives they will need to resolve. In all small group exercises, all members of the group share responsibility for analyzing and explaining the clinical presentations. The value of small group exercises is not always the “answer,” but the reasoning behind it. Basic and clinical science faculty will be present to ask helpful questions if your group is “stuck” and to encourage your curiosity. During small group exercises, you are free to use any resources (unless otherwise instructed). At the end of each small group exercise, you will be expected to review the complete cases and create a summary in your own words of the “take home” points of the cases considered as a group. Summarizing and paraphrasing in your own words is a powerful learning tool.

Preceptorship (attendance required) Note: Due to the escalating situation with COVID-19, M2 fall Preceptorship in its normal form will not take place in AY2021-2022. Every effort is being made to arrange some similar patient experiences later in the fall, conditions permitting. Approximately every other week each student will spend a half day in the office of a community physician assigned as their Preceptor. Attendance at these sessions and documentation of patient encounters in the Encounter Tracking System (ETS) no later than midnight of the day of each preceptor visit are required.

PICO Assignment

PICO is a format physicians can use for converting clinical scenarios to researchable and answerable questions to provide evidence-based care of patients. This format can be used to answer questions about treatment, diagnosis, risk factors, etiology, statistics and phenomena. P = Patient, Population and/or Problem I = Intervention, treatment, Prognostic factor, and/or Exposure (Which specific are you considering?) C = Comparison and/or Control (What is the main alternative to the above?) O = Outcome (What are you trying to accomplish, improve, or effect?)

During the Musculoskeletal and Integumentary Systems block each student will develop a clinically relevant question, framed using the PICO format. Students will independently research the answer to their question, evaluate, and report the results of their search. The completed assignment is to be submitted via Canvas no later than 5:00 pm, Friday, December 3, 2021. Supporting materials and suggestions about PICO questions and EBM resources for answering these questions are available with the assignment on Canvas.

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Clinical Learning Sessions (CLC) (attendance required) Throughout the block learners will continue to develop their clinical skills and clinical reasoning during individual or paired encounters in the CLC. These encounters will not be restricted to the exam or problems associated with the specific system being studied in the block. They will often include reviews of prior organ systems and demonstrations of how systems intersect and impact one another.

Critical Reading/Critical Analysis of Literature Assignment (aka Journal Club)

Each course in the fall and spring semesters of the pre-clerkship curriculum includes one or more large or small group sessions related to the interpretation of primary literature. Prior to each of these required sessions, each student reads the assigned paper and completes and submits the guided reading template posted on Canvas. This guided reading template – which reflects the organization of the New England Journal of Medicine Quick Takes format – helps develop student skills that are critical for interpreting primary literature necessary for practicing Evidence-based Medicine and for keeping up with important biomedical research. Completion of the template by all students prior to the session assures readiness for meaningful in-class analysis and discussion.

At least once each semester, the Journal Club will take place in small groups. When scheduled as a small group, individual students will be assigned to lead the discussion, and all students will be assessed on their preparation and participation. Interprofessional Collaborative Skills (ICS)

All ICS assignments, templates, links and submissions are through the Class of 2024 Interprofessional Collaborative Skills course site on Canvas.

During the Fall semester, students complete the activities related to Team work and patient safety. The final assignment – a Reflection on communication errors and Care Team activities to reduce and/or address such errors -- based on experiences in SCP and the Interprofessional immersion activity – is due no later than 11:59 PM on Monday, December 6, 2021.

Professionalism

Medicine is a Profession, which means it entails unique responsibilities and obligations as well as unique privileges. “Professional identity formation” is an objective as important as learning the sounds and anatomy of the heart, but requires a different set of learning skills. Important among those are integrity, reflection, self- and peer assessment, deliberate practice, and learning for mastery (not grades).

Two essential Professional behaviors that will become a part of your everyday life are founded on respect for patients:

Confidentiality: Patients — including Standardized Patients — deserve to be treated with respect. Respect for patients includes keeping all patient information confidential. Patient information may be shared with other health care professionals that have a legitimate, professional “need to know,” or with specific family members, friends, or others that have permission from the patient for access to the information.

Be especially conscious about discussions of patients in public places. Even when patient names are not used, the discussion may reveal the patient’s identity to others who overhear the discussion. Rather than risk a violation of patient confidentiality, discuss patients only in a private setting and only with individuals who have a legitimate need to know.

Be careful to keep all patient notes, reports and materials confidential. Patient records, should be returned to faculty, destroyed, or kept in a secure place.

Similarly, your classmates deserve to be treated with respect. Information learned about your classmates and their families while in class is considered confidential. You are not free to disclose this material to others without the specific consent of the person.

Violation of confidentiality may result in a Report of Concern for Unprofessional Behavior and may be referred to the Student Evaluation and Promotion Committee (SEPC). Egregious unprofessional behavior of any variety may result in suspension of the student, a failing grade for the course, and/or referral to SEPC.

Professional Attire: Medical students, faculty and staff are all ambassadors and representatives of the College of Medicine and of the medical profession. Appearance and behavior should at all times demonstrate respect for the profession and for our patients. The needs of patients must always come first, and any barriers to meeting those needs (including attire, appearance and grooming) must be removed.

Professional attire should be worn in settings where students interact with people from outside the COM, and particularly when interacting with Standardized Patients (SPs) in the CLC, on a “house visit,” or when in a preceptor's office or clinic, a hospital or nursing facility. Professional attire should also be worn when patients, guests, or visitors are present in large or small group sessions.

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Specific standards for professional attire are detailed at the end of this document and can always be found on the course Canvas site (the University Learning Management System).

Content

Musculoskeletal and Integumentary Systems is organized in 4 modules:

Spanning all modules of this block, continued development of clinical reasoning and clinical skills focuses on advanced history taking, advanced physical exam maneuvers, and the interpretation of common diagnostic tests relevant to these systems. Standardized patient interactions continue with emphasis on clinical reasoning skills using problem oriented and chronic disease encounters that are not limited to block-specific content.

Skin

Atopic, autoimmune, genetic, infectious, systemic, neoplastic, and traumatic disorders Diagnosis and management, pharmacological and non-pharmacological

Bone Arthritic disorders: osteoarthritis, gout, infectious Traumatic injury, back, neoplastic and osteoporotic disorders Calcium homeostasis across the lifespan Acute and chronic pain syndromes Diagnosis and management, pharmacological and non-pharmacological

Rheumatology Mechanical, immune and autoimmune disorders including: rheumatoid arthritis, lupus, Sjogren’s syndrome Diagnosis and management, pharmacological and non-pharmacological

Muscle Neuromuscular disorders: inherited, toxic, sarcopenic, neoplastic, traumatic and atrophic Acute and chronic pain syndromes Diagnosis and management, pharmacological and non-pharmacological

Required Materials (All required texts are available as ebooks through COM library course page)

OnlineMedEd Individual subscription provided by the COM (log in with your COM email address) Basic and Clinical Pharmacology (Katzung) Bates Guide to Physical Examination and History Taking Behavioral Science in Medicine (Fadem) Cecil Essentials of Medicine (Wing) Histology: A Text and Atlas With Correlated Cell and Molecular Biology (Ross) How the Immune System Works (Sompayrac) Physiology (Costanzo) Resolving Ethical Dilemmas: A Guide for Clinicians (Lo)

Robbins and Cotran Pathologic Basis of Disease (Kumar)

Sherris Medical Microbiology (Ryan) Smith's Patient-Centered Interviewing: An Evidence-Based Method (Fortin) Understanding Health Policy: A Clinical Approach (Bodenheimer)

Additional required readings will be assigned from a variety of sources. These readings will be provided to you and posted on Canvas when possible.

Other materials required for clinical sessions

a. Clinical examination equipment: Each student must purchase and/or have available the following clinical examination equipment: stethoscope with diaphragm, bell and pediatric option, oto/ophthalmoscope, 128Hz and 512Hz tuning forks, penlight, reflex hammer, Rosenbaum eye chart and a sphygmomanometer with pediatric, adult, and large adult sized cuffs. Opportunities to purchase this equipment at a discount will be provided prior to orientation. Bring your examination equipment with you to each CLC session.

b. Also bring the following to each session in the CLC: A watch capable of measuring seconds

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A pen for writing (blue or black ink) The student’s personal mobile device loaded with the appropriate medical software/applications.

Grading System

Description of Student Assessment Methods and Grading

Examinations There will be one assessment in the course. This exam will be comprised wholly or in part of questions from the NBME (National Board of Medical Examiners) question bank. The questions on the customized NBME exam will be selected by course faculty as appropriate assessment of course objectives. A formative practice exam and/or other assessment exercises will be offered throughout the course but do not contribute to the final grade.

Written exams Multiple choice and other question formats are used to assess both content knowledge and application skill (ability to solve problems, demonstration of clinical reasoning, interpretation of images and laboratory results, etc.) on written exams. Exam questions may be drawn from material presented in any activity or assignment, from assigned readings, and from CLC sessions, in addition to questions from the NBME question bank. Exams are cumulative across the curriculum, i.e., main concepts, content and skills from material presented in prior courses may be included in questions. Written questions may also be presented in context with standardized patient encounters during the examination.

Students must score a cumulative average of ≥70% on all exam questions to pass the written examination component of the course. Students with a written exam average below 70% risk failing Musculoskeletal and Integumentary Systems, and being referred to the Student Evaluation and Promotions Committee.

Clinical skills exams / Objective Structured Clinical Examination (OSCE) Formative and summative assessment of clinical skills occurs periodically throughout the preclerkship phase. OSCEs are skills-based examinations conducted in the CLC to assess the student’s ability to demonstrate clinical skills and behaviors. OSCEs typically consist of several “stations.” Each station will require the student to demonstrate one or more clinical skills/behaviors that will be assessed by a trained observer using established performance criteria for that assessment. The passing score for an OSCE is ≥80%. Students who do not achieve a score of 80% or higher on the formative OSCE must develop a plan to remediate these clinical skills.

Practice exam A formative faculty-written practice examination will be made available after the Thanksgiving break for students to use as part of their exam preparation. It is recommended that students take the examination without collaboration or consulting resources (e.g. textbooks, peers, notes, websites, etc.) in order to give themselves a fair assessment of their current state of knowledge. The practice exam is an important opportunity for students to practice the self-assessment and responsibility for their own learning that are part of Professionalism and Practice Based Learning and Improvement. Answers and rationale for each question are provided to assist students in modifying their study strategy accordingly and identifying resources that will help them succeed in the curriculum. Grading The FSU COM has adopted a pass/fail grading system which is used in the curriculum for the first and second years (See Student Handbook). To achieve a grade of Pass in BMS 6047 Musculoskeletal and Integumentary Systems a student must earn a minimum of 165 points as described in the table below, including a minimum of 111 points from the assessment categories. The final grade of a student who accumulates169 total points but has not achieved the minimum required number of points in any non-assessment category will be at the discretion of the course directors following discussion and any required remedial action:

Category Criteria for points Points MINIMUM REQUIRED

MAXIMUM POSSIBLE

ASSESSMENTS (Minimum total points required = 111)

End of course exam Overall score of ≥ 75% 100 points

90 100 Overall score 70-74.9% 90 points Score < 70% 0 points

OSCE Satisfactory performance 20 points

16 20 Satisfactorily remediated performance 16 points Failed remediation 0 points

Weekly quiz (x 3)

On time and ≥ 70% 3 points each

5 9 On time and between ≥ 65% but <70% 2 points each On time and between ≥ 50% and < 65% 1 point each Late (even if 100%) 0 points

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NOT SUBMITTED or > 24 h late - 2 points TOTAL ASSESSMENT 111 129

NON-ASSESSMENT CATEGORIES (Minimum total points required = 58)

CLC (x 2) On-time arrival 1 point each

4 4 Evidence of preparation 1 point each

Clinical skills small group (x 2) On-time arrival 1 point each

4 4 Evidence of preparation 1 point each

Discussion rounds (x 2) Attendance 1 point each 3 4

Required small group Jigsaw 11/18 11/23

Part 1 on-time arrival 1 point each

7 8 Participation in Part 1 break out small group 2 points each

Participation in Part 2 large group debrief 1 point each Required session attendance (To receive credit, you must be present for the entire session) Intro 11/16 Advanced upper

extremities exam 11/18 Advanced lower

extremities exam 11/18 Shoulder injuries 11/23 Pt presentation 11/29 Neoplasia 12/02 Pt presentation 12/06 Trauma 12/09 Critical reading 12/10 Pt presentation 12/10

On-time arrival 1 point each

16 20

Participation/Professionalism 1 point each

Assignments

Providing feedback assignment

On time submission Due 12/10 at 11:59 PM 1 point

3 4 Meets criteria: descriptive 1 point Meets criteria: specific 1 point Meets criteria: actionable 1 point

Receiving feedback assignment

On time submission Due 12/10 at 11:59 PM 1 point

3 4 Meets criteria: receptive 1 point Meets criteria: active listening 1 point Meets criteria: action plan 1 point

Critical reading template On time submission Due 12/9 at 11:59 PM 1 point

2 3 Evidence of effort 2 points

PICO assignment On-time submission due 5:00 PM 12/03 1 point

2 3 Adequate effort and timely resubmission if requested

2 points

Interprofessional collaborative skills module:

3 4 Reflection on communication errors and Care Team activities to reduce and/or address such errors

On-time submission Due 12/6 at 11:59 PM 1 point

Adequate effort and evidence of learning across SCP, Preceptorship and the Immersion activity 3 points

Professional Identity Formation General professionalism (includes Professionalism in CLC and Small groups) -1 point/event 11 15

TOTAL NON-ASSESSMENT 58 73 TOTAL 169 202

For your convenience – here is a table of the due date and time for all assignment submissions Assignment Date due (no later than) Time due PICO Friday, December 3 5:00 PM

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Providing feedback Friday, December 3 11:59 PM Receiving feedback Friday, December 3 11:59 PM Reflection on care team communication errors (ICS Canvas site)

Monday, December 6 11:59 PM

Critical reading template Thursday, December 9 11:59 PM

1. An end of course exam average between 70% and 74.9% (90 points) is considered a “marginal” pass. Students in this category are encouraged to consult the academic counselors in Student Affairs as well as the course faculty for advice on study and test-taking skills. An end of course exam average < 70% (0 points) will receive a grade of fail* (see Grading Policy below), which will require remediation or repetition of the course, as proposed by the course directors and determined by decision of the Student Evalu56ation and Promotion Committee.

2. A student whose performance is <70% (below passing) on any individual exam during the course is required to a. Attend the exam review, b. Contact the course directors within 24 hours of that exam review, and

c. Meet with the course directors.

3. Any quiz not completed by the Monday 8 AM deadline will earn 0 points. Any quiz submitted >24 hours late will result in a 2 point deduction from the quiz category points.

4. A student who achieves an overall passing score (≥ 70%) but has demonstrated a significant deficit in one or more content areas will be required to develop and complete a Performance Improvement Plan in consultation with the course directors. The purpose of the Plan is to assure the student has the requisite knowledge base to succeed in subsequent courses in the curriculum.

5. Attendance and satisfactory participation in all required sessions, all activities scheduled in the CLC, and other activities as determined by the course directors and clinical skills director. Unexcused absence from an activity for which attendance is required may require remediation as determined by the course directors. Multiple unexcused absences from required activities will be considered a Professionalism concern and may result in a Report of Concern for Unprofessional Behavior and referral of the student to the Student Evaluation and Promotions Committee.

6. Demonstration of the attitudes and behaviors of Medical Professionalism in all aspects of the course, including adherence to the Honor Code, adherence to COVID-19-related safety protocols and behaviors, and observation of the dress code. Professionalism concerns may generate a Report of Concern for Unprofessional Behavior (see Student Handbook) and may result in receiving a grade of fail in the course.

7. Satisfactory completion of all assignments, including interprofessional collaborative skills activities, as determined by the course directors. Preclerkship course grading policy – Year 2

Course written exam score: All quizzes are mandatory and must be completed without collaboration or consulting resources (e.g., textbooks, peers, notes, websites, etc.).

The Pass value for an in-house exam is 70%. The Pass value for an NBME exam in an M2 course is set as the national p value for the selected questions, minus 10 points OR 70%, whichever is LOWER (i.e., never higher than 70%). Students will be informed of the NBME p value prior to the exam. For written exams that incorporate both in-house and NBME questions, the passing score for the combined written exam will reflect the proportion of in-house and NBME questions on the exam.

Course grade: If the written exam score is below passing as defined above, a grade of IR will be recorded.

In courses that include an OSCE: OSCE score < 80%, if the course written exam score is Pass OR IR (see above) = IR

In courses that include Preceptorship (M1 Spring, M2 Fall) Unsatisfactory performance in Preceptorship, if the course written exam score is Pass OR IR = IR

Unsatisfactory Professionalism, if the course written exam score is Pass OR IR = IR or Fail depending on the nature of the Professionalism concern, as determined by the Student Evaluation and Promotion Committee (SEPC).

In any course in which the student’s performance merits a grade of IR in 2 or more of the above categories (written exam score, OSCE, Preceptorship, Professionalism), the student will be referred to the SEPC, and a grade of Fail may be awarded, as determined by the SEPC.

Pre-clerkship course remediation policy – Year 2:

A student who has completed all the assessments and activities of a course and has not achieved a passing score (see above), will be required to demonstrate competence through an assessment which is consistent with the original course. Remediation activities, including final testing, may involve other students. For an M2 course:

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Students with a score < 10 points below Passing (as defined above) remediate the week after the course ends by taking an individually tailored, open-ended question (essay) format exam.

Students with a score ≥ 10 points below Passing (as defined above) remediate by taking another NBME exam – the same, or slightly modified from the original. 1. For an M2 Fall course, remediation occurs over Thanksgiving or Winter break. 2. For an M2 Spring course, remediation occurs in the first 2 weeks of dedicated Step 1 study. Course remediation will be integrated

with the student’s use of UWorld blocks as part of the study plan. If a student has IR grades in 2 or more M2 courses they will be referred to the SEPC. A student who scores <70% on the remediation assessment or does not adequately engage in the remediation process (as monitored by the course directors) will receive a grade of Fail for the course and be referred to the SEPC

Course Evaluation

Students will have the opportunity to provide constructive feedback through evaluation forms completed throughout the semester. Evaluations will include both content and facilitation/teaching. Feedback is encouraged at all times on all components of the course and will assist the block directors in providing a timely continuous quality improvement.

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Policies

Americans with Disabilities Act

Florida State University (FSU) values diversity and inclusion; we are committed to a climate of mutual respect and full participation. Our goal is to create learning environments that are usable, equitable, inclusive, and welcoming. FSU is committed to providing reasonable accommodations for all persons with disabilities in a manner that is consistent with academic standards of the course while empowering the student to meet integral requirements of the course. Candidates for the M.D. degree must be able to fully and promptly perform the essential functions in each of the following categories: Observation, Communication, Motor, Intellectual, and Behavioral/Social. However, it is recognized that degrees of ability vary widely between individuals. Individuals are encouraged to discuss their disabilities with the College of Medicine’s Director of Student Counseling Services and the FSU Office of Accessibility Services to determine whether they might be eligible to receive accommodations needed in order to train and function effectively as a physician.

The Office of Student Counseling Services Medical Science Research Building, 2301 Phone: (850) 645-8256Fax: (850) 645-9452

To receive academic accommodations, a student:

1) must register with and provide documentation to the Office of Accessibility Services (OAS); 2) must provide a letter from OAS to the instructor indicating the need for accommodation and what type; and 3) should communicate with the instructor, as needed, to discuss recommended accommodations. A request for a meeting may be initiated by the

student or the instructor. Please note that instructors are not allowed to provide classroom accommodations to a student until appropriate verification from the Office of Accessibility Services has been provided.

This syllabus and other class materials are available in alternative format upon request. For more information about services available to FSU students with disabilities, contact the:

Office of Accessibility Services 874 Traditions Way 108 Student Services Building Florida State University Tallahassee, FL 32306-4167 Voice: (850) 644-9566 TDD: (850) 644-8504 oas@fsu.edu https://dsst.fsu.edu/oas

Academic Honor Code

The Florida State University Academic Honor Policy outlines the University's expectations for the integrity of students' academic work, the procedures for resolving alleged violations of those expectations, and the rights and responsibilities of students and faculty members throughout the process. Students are responsible for reading the Academic Honor Policy and for living up to their pledge to "...be honest and truthful and...[to] strive for personal and institutional integrity at Florida State University." (Florida State University Academic Honor Policy, found at http://fda.fsu.edu/Academics/Academic-Honor-Policy)

Attendance Policy

University Attendance Policy: Excused absences include documented illness, deaths in the family and other documented crises, call to active military duty or jury duty, religious holy days, and official University activities. These absences will be accommodated in a way that does not arbitrarily penalize students who have a valid excuse. Consideration will also be given to students whose dependent children experience serious illness.

The College of Medicine has detailed attendance policies as they relate to each cohort and events that conflict with course schedules. See pages 28-29 of FSUCOM Student Handbook for details of attendance policy, notice of absences and remediation.

Unexcused absence from a scheduled examination or quiz may result in a score of zero (0 %) being assigned for that assessment. Unexcused absence from an activity for which attendance is required (for example, Small Group session) may be considered as an issue of Professionalism. Any unexcused absence may require completion of the Performance Improvement Plan (see Grading section, above).

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Clinical Learning Center (CLC) Specific Absence Policy

CLC scheduled activities

Students with a legitimate reason to miss a scheduled session in the CLC must request an approved absence through Student Affairs through the online link. Students with approved absences will be allowed to reschedule or participate in a make-up session. Unapproved absences may not be rescheduled or made up. Repeated unapproved absences may result in a failing grade for the course and a Report of Concern for Unprofessional Behavior.

If you know you will be absent from a scheduled CLC session, please complete the absence approval request at least two weeks in advance. For absences that are approved at least two weeks in advance, a change in CLC schedule assignment will be arranged.

One method for addressing a planned and approved absence is to identify a classmate willing to exchange scheduled sessions with you. In this situation, both students (the student with the approved absence and the willing classmate) should send a request via email to the CLC Team at least two weeks in advance. Students will be notified re: approval of these requests. Please note: Sending a request is NOT equivalent to receiving approval.

Unplanned but excusable absences from CLC sessions are absences due to circumstances beyond the student’s control. Examples include student illness and/or family death. When such a situation occurs, please contact the CLC Team as soon as possible, to inform her that you will not be present. Then, submit an absence request to Student Affairs through the online link. Student Affairs will classify the absence as excused or unexcused.

If the absence qualifies as an “excused” absence, the student must contact the CLC Team to develop a plan to make up the missed session. These sessions may require the presence of an SP and or CLC faculty member. Any excused absence will not impact the student’s grade.

Unexcused absences generally involve circumstances within the student’s control. Examples of unexcused absences include the student who forgets about a scheduled CLC session, the student who skips the session to study, and/or any absence where an able student fails to contact Student Affairs and the CLC Team to inform them that the student will not be present for the session.

If the absence is unexcused, the clinical skills director will discuss the situation with the student. Any further unexcused absences will result in the notification of Student Affairs, a Report of Concern for Unprofessional Behavior, and referral of the student to the Student Evaluation and Promotions Committee. Students with unexcused absence(s) will still be responsible for the missed material in future OSCE’s and written examinations.

Objective Structured Clinical Examination (OSCE)

If a student knows he/she will not be able to participate in the OSCE, he/she should complete and submit the appropriate forms to Student Affairs, and, if within 24 hours of the time he/she is scheduled for the OSCE, contact the CLC Team If the absence is excused by Student Affairs, the student will receive an “I” (incomplete) grade and be required to complete a make-up OSCE at a designated time after the course has ended.

Any excused absence—whether planned or unplanned—will not impact the student’s grade.

Any absence that does not qualify as an excused absence per Student Affairs is an unexcused absence. These generally are due to circumstances within the student’s control. Examples of unexcused absences include the student who forgets about an OSCE session, the student who skips an OSCE to study for an exam and/or any absence where an able student fails to follow the procedures above if they are not able to participate in the OSCE. An unexcused absence will result in failure of both the OSCE and the course.

Professional Attire

Professional attire consists of clothes consistent with community norms for physicians. Length and fit of all attire is to be in accordance with that acceptable for physicians in a professional healthcare environment; oversized, undersized, tight-fitting, seductive, and/or revealing clothing is not acceptable.

Unacceptable attire includes, but is not limited to, the following: jeans of any style or color, denim material or "denim look" material, sheer or see-through fabrics, strapless, low-necked or exposed chest clothing, midriff-baring clothes, backless clothing, spaghetti straps, cut-offs, tank tops, halter

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tops, crop tops, tube tops, sun dresses, crop pants, shorts, pedal pushers, hip hugger pants, stirrup pants, any item constructed mainly of spandex, sweat suits (sweat pants/sweat shirts), warm-up suits, overalls, hats, and any clothing that advertises.

Examples of professional attire in Tallahassee are: slacks or skirt and a collared shirt or blouse or sweater; conservative length dress (dress or skirt edge should rise no higher than 2” above the top of the knee-cap (patella) during all clinical care and training maneuvers including sit down patient-clinician conversations; dress or skirt should not be tight fitting)..

Ties may be either required or forbidden in some clinical situations.

Footwear may include dress or casual closed toe shoes (no sports shoes, no sandals, no open-toe footwear). Heels more than 3” in height are never appropriate in clinical settings.

Consult your supervisor to clarify expectations for student attire in any ambiguous or new situations.

Professional appearance: Long hair must be pulled back and secured. Facial hair must be neatly groomed. If possible, all tattoos should be covered by clothing. No visible body piercing except a single piercing in each ear. No large earrings or loose jewelry. Fingernails must be trimmed. If nail polish is worn, it should not be a distracting color. No strong perfume or other scented products. In compliance with OSHA regulations, closed-toed shoes are required in all clinical settings—including the CLC.

The established "norms" of certain clinical settings may modify these standards for professional attire, but any variations in professional attire must be approved by the student's supervisor. Consult your supervisor to clarify expectations for student attire in any ambiguous or new situations.

For curricular activities where guests or patients are not present: Unacceptable attire includes, but is not limited to, the following: sheer or see-through fabrics, strapless, low-necked or exposed chest clothing, midriff-baring clothes, backless clothing, spaghetti straps, cut-offs, tank tops, halter tops, crop tops, tube tops, or extremely short shorts.

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FSU COM Education Program Objectives

1 PATIENT CARE: Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

1.1 Perform all medical, diagnostic, and surgical procedures considered essential for the area of practice

1.2 Gather essential and accurate information about patients and their conditions through history-taking, physical examination, and the use of laboratory data, imaging and other tests

1.3 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient 1.4 Interpret laboratory data, imaging studies, and other tests required for the area of practice

1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment

1.6 Develop and carry out patient management plans

1.7 Counsel and educate patients and their families to empower them to participate in their care, showing consideration for their perspective throughout treatment

1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes

1.9 Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health

1.10 Provide appropriate role modeling

2 KNOWLEDGE FOR PRACTICE: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care

2.1 Demonstrate an investigatory and analytic approach to clinical situations 2.2 Apply established and emerging bio-physical scientific principles fundamental to health care for patients and populations

2.3 Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health care

2.4 Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations

2.5 Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial-cultural influences on health, disease, care-seeking, care-compliance, barriers to and attitudes toward care

2.6 Contribute to the creation, dissemination, application, and translation of new health care knowledge and practices

3 PRACTICE-BASED LEARNING AND IMPROVEMENT: Demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning

3.1 Identify strengths, deficiencies, and limits in one’s knowledge and expertise 3.2 Set learning and improvement goals 3.3 Identify and perform learning activities that address one’s gaps in knowledge, skills or attitudes

3.4 Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement

3.5 Incorporate feedback into daily practice 3.6 Locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems 3.7 Use information technology to optimize learning 3.8 Participate in the education of patients, families, students, trainees, peers and other health professionals

3.9 Use information technology to obtain and utilize information about individual patients, populations of patients being served or communities from which patients are drawn to improve care

3.10 Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes

4 Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals

4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

4.2 Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies

4.3 Work effectively with others as a member or leader of a health care team or other professional group 4.4 Act in a consultative role to other health professionals 4.5 Maintain comprehensive, timely, and legible medical records

4.6 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about issues such as death, end-of-life, adverse events, bad news, disclosure of errors, and other sensitive topics

4.7 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions

5 PROFESSIONALISM: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles

5.1 Demonstrate compassion, integrity, and respect for others 5.2 Demonstrate responsiveness to patient needs that supersedes self-interest 5.3 Demonstrate respect for patient privacy and autonomy 5.4 Demonstrate accountability to patients, society and the profession

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5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

5.6 Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations

6 SYSTEMS-BASED PRACTICE: Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care

6.1 Work effectively in various health care delivery settings and systems relevant to their clinical specialty 6.2 Coordinate patient care within the health care system relevant to their clinical specialty 6.3 Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care 6.4 Advocate for quality patient care and optimal patient care systems 6.5 Participate in identifying system errors and implementing potential systems solutions 6.6 Work in interprofessional teams to enhance patient safety and improve patient care quality

7 INTERPROFESSIONAL COLLABORATION: Demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care

7.1 Work in cooperation with other professionals to establish and maintain a climate of respect, dignity, diversity, ethical integrity, and trust in order to enhance team functioning and serve the needs of patients, families, and populations

7.2 Utilize and enhance one’s own expertise by understanding and engaging the unique and diverse knowledge, skills, and abilities of other professionals to enhance team performance and maximize the quality of patient care

7.3 Exchange relevant information effectively with patients, families, communities, and other health professionals in a respectful, responsive, and responsible manner, considering varied perspectives and ensuring common understanding of, agreement with, and adherence to care decisions for optimal outcomes

7.4 Participate in and engage other members of interprofessional patient care teams in the establishment, development, leadership, and continuous enhancement of the team in order to provide care that is safe, timely, efficient, effective, and equitable

8 PERSONAL AND PROFESSIONAL DEVELOPMENT: Demonstrate the qualities required to sustain lifelong personal and professional growth

8.1 Develop the ability to use self-awareness of knowledge, skills and emotional limitations to engage in appropriate help-seeking behaviors

8.2 Demonstrate healthy coping mechanisms to respond to stress 8.3 Manage conflict between personal and professional responsibilities 8.4 Practice flexibility and maturity in adjusting to change with the capacity to alter behavior 8.5 Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients 8.6 Provide leadership skills that enhance team functioning, the learning environment, and/or the health care delivery system 8.7 Demonstrate self-confidence that puts patients, families, and members of the health care team at ease

8.8 Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty

9 FSU COM MISSION: Demonstrate responsiveness to community needs – especially elder, rural, minority and underserved populations

9.1 Describe the social determinants of health, and identify how they create opportunities for and barriers to wellness for underserved populations.

9.2 Identify community resources and the ways physicians can partner with them to improve individual and population health and address social determinants of health.

9.3 Discuss the process and components of community health assessment.

9.4 Illustrate how community health assessment is used to identify the health needs and issues of a given population and inform decision making to improve population health status.